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The Merger: MDs and DOs in California is an important read on medical history. This unique and well-documented book carefully and, in my opinion, accurately explores a period when two groups of physicians—osteopathic and allopathic—joined in an effort to optimize patient care, education, and research in California. This merger process was not easy and caused great debate and controversy. A small but persistent group of osteopathic physicians refused to accept the merger and fought long and hard to maintain a distinct osteopathic medical presence in California.

The Merger takes the reader through the entire experience of California osteopathic physicians in a comprehensive, unbiased manner using all available historical documentation and key verbal testimony from numerous eyewitnesses. The authors are medical school faculty at prominent universities. Dr Reinsch is a research specialist and Dr Tobis is a research professor in the Department of Physical Medicine and Rehabilitation at the University of California at Irvine. Dr Seffinger is an associate professor in the Department of Osteopathic Manipulative Medicine at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, California.

The book begins with a detailed chronology of the DO-MD relationship in California, from the opening of the first osteopathic medical college outside of Missouri (the Pacific Sanitarium and School of Osteopathy in Anaheim, California) in the 1890s to the various interactions between DOs and MDs in the early 2000s. Seven chapters then cover numerous issues associated with the DO-MD relationship in California.

In chapter 1, the authors explain the differences between osteopathic and allopathic physicians, as well as how osteopathic medicine began in California. In subsequent chapters, many aspects of early osteopathic medicine, including practice, education, and research, are reviewed. The osteopathic medical profession in California has a unique history—certainly different from the profession's history throughout the rest of the United States. For example, chapter 3 traces the state's “dual degree” controversy to events in the 1930s and 1940s, including the founding of Metropolitan University, a short-lived university started by osteopathic physicians that granted MD degrees to DOs in the mid-1940s.

California osteopathic medical schools and hospitals were established as the profession matured. The authors make it clear that this process of maturation was turbulent. At times, the osteopathic medical profession came close to extinction in the state. At other times, however, the osteopathic medical profession received substantial acceptance and recognition by the allopathic medical profession.

The Merger covers the pioneering research in the early 1900s by Louisa Burns, DO, (“the first person in the osteopathic profession to establish and carry out a long term research program”) and other individuals who played important roles in establishing the osteopathic medical profession as a valuable contributor to medical care and science in California. Much of this scientific creativity occurred during turbulent times for the osteopathic medical profession. The authors note that a primary reason for the merger was to enhance osteopathic medical research by enlisting the expertise of MDs and allopathic institutions, which had more investigative experience and financial support than osteopathic institutions.

Chapter 5 focuses on issues related to coping with the merger from the 1960s to the 1980s. Many DOs became MDs, while osteopathic hospitals and medical societies and a school (College of Osteopathic Physicians and Surgeons in Los Angeles) changed hands or were altered substantially. Heroes and villains emerged, but agreement as to who fits into each of these categories remains a subject of debate. The changes in California affected osteopathic medicine throughout the nation.

Part of the merger, as pointed out in chapter 6, was the formation of the 41st Medical Trust at the University of California, Irvine, in 1964. This trust, which existed for 20 years, furthered the unification of DOs with MDs and supported research in osteopathic manipulative treatment. The Merger was produced with support from the California College of Medicine Support Foundation in Irvine, California—the successor to the 41st Medical Trust.

In the book's final chapter, the authors look at the future of osteopathic medicine in California, including patient needs and preservation of professional identity in the 21st century. Suggestions for future directions from numerous contributors are also included. An appendix features brief biographies of contributors and of key historical osteopathic and allopathic physicians.

I read The Merger twice. It is filled with facts, photographs, historical information, and personal testimonies from interviews. The first read was interesting, but the second time around was fascinating. This book tells a story about professional survival and eventual success.